(1080) Prenatal opioid use disorder exposure and infant mortality

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Long-term outcomes among infants born to mothers with opioid use disorder (OUD) are not fully characterized, nor is it well understood whether risks may be modified by infant diagnosis with neonatal opioid withdrawal syndrome (NOWS). The objective of this study is to characterize risks of post-neonatal mortality among infants born to women with OUD or with a NOWS diagnosis.

Study Design: We conducted a retrospective cohort study of mother-infant dyads enrolled in Tennessee Medicaid having live births between 2007-2018. We defined baseline characteristics and infant mortality using administrative claims linked to birth and death certificates. The primary exposure was NOWS diagnosis after birth or maternal OUD diagnosis, categorized as maternal OUD with NOWS (OUD+/NOWS+); maternal OUD without NOWS (OUD+/NOWS-); no documented maternal OUD with NOWS (OUD-/NOWS+); and no maternal OUD or NOWS (OUD-/NOWS-). We defined NOWS using diagnosis codes and maternal OUD using both diagnosis codes or maintenance medication prescription fills. The outcome was post-neonatal infant death between days 29-365 after birth. We used Cox proportional hazards models adjusting for baseline maternal and infant characteristics to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs).

Results: Of 390,075 infants, 4,922 (1.26%) met our definition for OUD+/NOWS+; 7,196 (1.84%) for OUD+/NOWS-; and 2,239 (0.57%) for OUD-/NOWS+. Survival was significantly decreased for all exposure groups, relative to the unexposed (OUD-/NOWS-) (Figure 1). After adjusting for relevant confounders, the risk of post-neonatal death was elevated for all exposure groups compared to OUD-/NOWS-: OUD+/NOWS+ aHR: 1.54 (CI: 1.07, 2.21), OUD+/NOWS- aHR: 1.62 (CI: 1.21, 2.17), OUD-/NOWS+ aHR: 1.64 (CI: 1.02, 2.65).

Conclusion: NOWS diagnosis after birth or maternal history of OUD is associated with increased risk for post-neonatal mortality. Future work is necessary to understand how improving the diagnosis, treatment, and support for pregnant women with OUD can reduce the risk of infant mortality.

Coauthor(s)

SG
Sarah Grossarth, MPH
Vanderbilt University Medical Center
Nashville, Tennessee, United States
SO
Sarah S. Osmundson, MD,MSCR
Associate Professor
Vanderbilt University
Nashville, Tennessee, United States
AW
Andrew Wiese, MPH, PhD
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
SP
Sharon Phillips, MSPH
Associate in Biostatistics
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Amelie Pham, MD (she/her/hers)
Fellow
Vanderbilt University Medical Center
Nashville, Tennessee, United States
LA
Leech Ashley, MS, PhD
Vanderbilt University
Nashville, Tennessee, United States
SP
Stephen Patrick, MD, MPH, MS
Vanderbilt University
Nashville, Tennessee, United States
AS
Andrew Spieker, PhD
Assistant Professor of Biostatistics
Vanderbilt University Medical Center
Nashville, Tennessee, United States
CG
Carlos Grijalva, MD, MPH
Associate Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Primary & Presenting Author(s)

Margaret Adgent, MSPH, PhD (she/her/hers)
Research Associate Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States